Gonyea, Eluira Form VS.61. NEW YORK STATE DEPARTMENT OF HEALTH
OFFICIAL BURIAL (OR REMOVAL) PERMIT
12r This Permit can be signed only by the Local Registrar (Deputy or subregistrar) of the Primary Registration District (Town,
Village, or City) in which the death occurred after the FILING and acceptance of a CORRECT AND COMPLETE CERTIFICATE OF
DEATH, LEGIBLY WRITTEN IN DURABLE BLACK INK. Registered No....3..a.7__......._
Town
Dist. No.� 0 I County Village.-- ez,e,„.c.6, ,,,cca, del,
Eg
Or City (If city,give street address)
Name f deceased
Ingle, married, widows •
Sex. ...... . . . . or . . . divorced (write the word..... . ... .. .. . . Date of Death.. .... . 19..q.e
Ag Y ars 8 Months...... ..Q�.L. ..Days Bir place -te -4Z-41--e"--a-4
Cause of Death.. .. � .. ,... . . `'�4
Certificate was by... :. ..:. . . . .. . ,.....17e.S. .... .. ✓ ... .. Y. M.D.
Address ' r.. .. •.: d .,. : c'-V Q.
..,46,91\
Place of Burial (or Removal). c r:u.rz.c 1 . .
(If body is to be a orar ld fil n space later) Q
Cemetery Date of Burial/.k�e / 19140
(If body is to be temporarily he d, fill in space later)
The Certificate of Death containing the above stated particulars, having been presented to me, after careful exami-
nation, the same appearing to be COMPLETE, CORRECT, AND SATISFACTORY AS REQUIRED BY LAW,
I have accepted the same for registration, have recorded it in my Local Record with the above stated Registered
Nu r, and ontlr sisthr fI .XC PE MT w �
to.. c PP(//
. . . . . . . . .
(Address)
the ,r/ to hold temporarily and the body.
(Und aker or erson having charge of corpse) Inter,rer,o of Ise Jmfe [state how])
Dated i 7 19.9 (Signed)...
Local Registrar
This Permit is sufficient for the Removal (and Interment or Cremation of a to any part of the State (subject to local
cemetery or other regulations), unless removal is by common carrier, in which case a ransit Permit (VS No. 62) is required.
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